Specialty Update   |    
What's New in Pediatric Orthopaedics
Young-Jo Kim, MD, PhD1; Kenneth J. Noonan, MD2
1 Children's Hospital-Boston, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115. E-mail address: young-jo.kim@childrens.harvard.edu
2 K4/732 Clinical Science Center, Department of Orthopaedics and Rehabilitation, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792. E-mail address: noonan@orthorehab.wisc.edu
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Specialty Update has been developed in collaboration with the Council of Musculoskeletal Specialty Societies (COMSS) of the American Academy of Orthopaedic Surgeons.
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Biomet).

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Mar 01;91(3):743-751. doi: 10.2106/JBJS.H.01689
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The epidemiology, treatment, and outcome assessment of neonatal brachial plexus palsy continue to be refined. Foad et al.1 analyzed the Kids' Inpatient Database from 1997, 2000, and 2003 to determine the incidence of neonatal brachial plexus palsy in the United States and additionally to determine the risk factors associated with brachial plexus palsy. In the United States, the incidence was at least 1.51 ± 0.02 cases per 1000 live births, but it decreased over the study period. The identified risk factors were shoulder dystocia (100 times increased risk), exceptionally large birth weight (4.5 kg) (fourteen times increased risk), and forceps delivery (nine times increased risk). On the other hand, twin or multiple births and cesarean section delivery appeared to have a protective effect. There appeared to be other unknown factors that influenced the incidence of brachial plexus palsy as only 46% of all children with this condition had one or more of these risk factors. In fact, 56% of brachial plexus palsies were not associated with a difficult delivery. Finally, the only reliable predictor of shoulder dystocia was a previous episode of shoulder dystocia in the mother.
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